期刊
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
卷 22, 期 1, 页码 147-155出版社
AMER SOC NEPHROLOGY
DOI: 10.1681/ASN.2010050483
关键词
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资金
- National Heart, Lung, and Blood Institute [N01-HC-95159 through N01-HC-95165, N01-HC-95169, U01 HL080295]
- National Institute of Neurologic Disorders and Stroke
- NIDDK [1K23DK082793-01, R01DK 066488]
- [N01-HC-85079 through N01-HC-85086]
- [N01-HC-35129]
- [N01 HC-15103]
- [N01 HC-55222]
- [N01-HC-75150]
- [N01-HC-45133]
- DIVISION OF EPIDEMIOLOGY AND CLINICAL APPLICATIONS [N01HC055222, N01HC085084, N01HC015103, N01HC085086, N01HC095160, N01HC085085, N01HC095161, N01HC085079, N01HC095162, N01HC095164, N01HC035129, N01HC075150, N01HC085081, N01HC095159, N01HC045133, N01HC085083, N01HC095163, N01HC085082, N01HC085080, N01HC095165] Funding Source: NIH RePORTER
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [R44HL095169, U01HL080295, R43HL095169, R21HL095165] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES [K23DK082793, R01DK066488] Funding Source: NIH RePORTER
Although cystatin C is a stronger predictor of clinical outcomes associated with CKD than creatinine, the clinical role for cystatin C is unclear. We included 11,909 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) and the Cardiovascular Health Study (CHS) and assessed risks for death, cardiovascular events, heart failure, and ESRD among persons categorized into mutually exclusive groups on the basis of the biomarkers that supported a diagnosis of CKD (eGFR < 60 ml/min per 1.73 m(2)): creatinine only, cystatin C only, both, or neither. We used CKD-EPI equations to estimate GFR from these biomarkers. In MESA, 9% had CKD by the creatinine-based equation only, 2% had CKD by the cystatin C-based equation only, and 4% had CKD by both equations; in CHS, these percentages were 12, 4, and 13%, respectively. Compared with those without CKD, the adjusted hazard ratios (HR) for mortality in MESA were: 0.80 (95% CI 0.50 to 1.26) for CKD by creatinine only; 3.23 (95% CI 1.84 to 5.67) for CKD by cystatin C only; and 1.93 (95% CI 1.27 to 2.92) for CKD by both; in CHS, the adjusted HR were 1.09 (95% CI 0.98 to 1.21), 1.78 (95% CI 1.53 to 2.08), and 1.74(95% CI 1.58 to 1.93), respectively. The pattern was similar for cardiovascular disease (CVD), heart failure, and kidney failure outcomes. In conclusion, among adults diagnosed with CKD using the creatinine-based CKD-EPI equation, the adverse prognosis is limited to the subset who also have CKD according to the cystatin C-based equation. Cystatin C may have a role in identifying persons with CKD who have the highest risk for complications.
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